• Archives of Plastic Surgery
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• v.35 no.6
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• pp.687-691
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• 2008

Purpose: An inverted nipple presents both cosmetic and functional problems. It is a source of repeated irritation and inflammation, and interferes with nursing. In addition, its abnormal appearance may cause psychological distress. With consideration of its underlying pathophysiologic components and severity, a number of techniques have been introduced for correction of this anomaly. The diversity of techniques indicates the lack of a good, sustainable, and durable solution for this quite common problem. We report our method as an alternative solution for correcting of the inverted nipple. Methods: From August 2003 to November 2007, 273 nipples in 147 patients were treated. 126 patients had bilateral inverted nipples. Patient age at the operation ranged from 21 to 63 years(mean age, 34 years). All nipples were congenital anomaly. 45 nipples were graded as grade I, 179 nipples as II, and 49 nipples as III. In the our study, we made some modification to the classic purse-string suture: (1) twice purse-string suture: (2) excision of diamond-shaped skin at the nipple neck: (3) buried suture of the breast parenchyma at the nipple base: (4) some timely release of retraction using Bovie's electrocautery dissection at inner surface of the nipple neck. Results: The operation time averaged 15 minutes. The mean follow-up period ranged from 3 to 48 months, with an average of 8.4 months. There were no complications associated with the surgery, such as infection, hematoma, permanent sensory disturbance, or total nipple necrosis except temporary sensory loss in 9 cases, partial nipple necrosis in 7 cases, and recurred inversion in 15 cases. All patients except recurred inversion were satisfied with their results. Conclusion: We believe that our modified purse-string suture is a reliable, simple, safe, and effective method for correcting the inverted nipple.

• Archives of Plastic Surgery
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• v.43 no.4
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• pp.339-343
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• 2016

Background Numerous techniques have been used to achieve long-term projection of the nipple following nipple-areola reconstruction. However, the reconstructed nipple loses projection over time. We describe a technique that uses local flaps to improve the lost projection of reconstructed nipples. Methods Between November 2013 and March 2015, nine patients (11 nipples) underwent revisional nipple reconstruction for lost projection. Only C-H nipple reconstructions were included in this study. The medical history of each patient was reviewed and photographs were taken in front and lateral views. All patients attended routine follow-up visits. Deepithelialized triangular flaps were made on all four sides of the nipple and buried in the opposite corners in order to augment the volume of the nipple. Anchoring sutures were used to attach each triangular flap on the side opposite their point of origin, and the resulting defects were closed directly. Results This procedure was used successfully in nine patients (11 nipples). Adequate projection was achieved in all patients and no complications occurred. The average nipple height was 3 mm before operation, 7 mm one day after operation, 5 mm at the six-month follow-up, and 5 mm at the 12-month follow-up. The average nipple-areolar angle was $164^{\circ}$ before the operation, $111^{\circ}$ one day after the operation, $130^{\circ}$ at the six-month follow-up, and $133^{\circ}$ at the 12-month follow-up. Conclusions The method described provides a solution to the loss of projection in reconstructed nipples. We recommend this technique because it leads to better projection, greater volume, and a more natural shape.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.461-464
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• 2008

Purpose: Although the demand for the mammoplasty including reduction or reconstruction is remarkably increasing, the anthropometric measurement for the breast, especially about the nipple areola complex(NAC) of Korean women has not been reported recently. Therefore, the anthropometric measurement about the NAC was performed to suggest the standard size of NAC for Korean women. Methods: Two hundred and twenty five female volunteers in 20's through 50's were included for the study. Questionnaires including the diameter of NAC, the diameter, height of nipple, age, marital status, delivery and lactation history were distributed to the volunteers and collected. Results: The mean values of our study are as follows: the areola diameter is $30.93{\pm}10.07mm$, the nipple diameter is $10.21{\pm}4.14mm$ and the height of nipple is $6.54{\pm}3.74mm$. The diameter of nipple areola complex(NAC) is bigger in old ages. If the volunteers have the history of marriage, delivery and lactation, it is bigger, as well. The height of nipple closely related to individual characters except the correlation between height of nipple and age. Conclusion: It is important to have standard data for the nipple areola complex in order to have good aesthetic results of mammoplasty. Despite the importance, there are a few measurement data for the nipple areola complex(NAC) of Korean women. The result of our study is not the absolute parameter for breast surgery, however it can be used as the standard size for NAC in the Korean female during breast surgery.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.706-709
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• 2005

The absence of the nipple-areolar complex(NAC) in men are seldom stated, as a result of trauma, burn, mastectomy, or after the correction of extreme bilateral gynecomastia. A total of 50 healthy men aged 21 to 27 years were examined. We recorded the configuration (dimensions and shape) and the location of the NAC with respect to fixed skeletal anatomic landmarks. Of the 50 subjects examined, 44 had oval and 6 had a round NAC. The mean diameter for a round NAC was 24.3 mm. The center of the NAC was in the fourth intercostal space in 41 volunteers and in the fifth intercostal space in 9 of the subjects. To localize the NAC on the chest wall, at least three reproducible measurements proved to be necessary, composed of a horizontal line(distance from the midsternal line to the nipple, A), a medial oblique line(distance from the sternal notch to the nipple, B) and a lateral oblique line(distance from the acromioclavicular joint to the nipple, C). Using these three parameters, we recommend that the appropriate location can be calculated derived from the circumference of the chest.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.748-752
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• 2014

Background Gynecomastia is benign enlargement of breast tissue in males and is fairly common. Mastectomy not only helps in improving the shape of anterior chest, but can also improve the location of nipple. Therefore, a principle element of mastectomy design is defining the normal location of nipple based on major anatomical reference points. Here, the nipple location was compared for before and after gynecomastia surgery. In addition, the same was also compared between male patients undergoing gynecomastia surgery and control group of subjects without gynecomastia. Methods We retrospectively analyzed gynecomastia patients who underwent conventional subcutaneous mastectomy. Preoperative and postoperative anatomical landmark distances and chest circumferences were measured and compared to the same anthropometric data from 20 healthy adult male controls. Results Nipple locations were compared among 13 patients and 20 controls. The mean weight of resected breast tissue was 246 g, and overall patient satisfaction grade was 4.3 out of 5. In the patient group, the slopes for the height-distance from the sternal notch to the nipple and chest circumference-distance between the mid-line of the sternum and the nipple were 0.175 and 0.125 postoperatively, respectively. The slopes of the control group were 0.122 and 0.177, respectively; these differences were statistically significant (P<0.05). Conclusions Nipple positions were considerably lower in patients with gynecomastia than in control subjects. Subcutaneous mastectomy was associated with mild elevations, but postoperative locations were still lower compared to controls. Further efforts are needed to improve the location of postoperative nipple-areola complex in patients with gynecomastia.

• Archives of Plastic Surgery
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• v.43 no.5
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• pp.424-429
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• 2016

Background The objective of this paper was to describe a novel technique for improving the maintenance of nipple projection in primary nipple reconstruction by using acellular dermal matrix as a strut in one of three different configurations, according to the method of prior breast reconstruction. The struts were designed to best fill the different types of dead spaces in nipple reconstruction depending on the breast reconstruction method. Methods A total of 50 primary nipple reconstructions were performed between May 2012 and May 2015. The prior breast reconstruction methods were latissimus dorsi (LD) flap (28 cases), transverse rectus abdominis myocutaneous (TRAM) flap (10 cases), or tissue expander/implant (12 cases). The nipple reconstruction technique involved the use of local flaps, including the C-V flap or star flap. A $1{\times}2-cm$ acellular dermal matrix was placed into the core with O-, I-, and L-shaped struts for prior LD, TRAM, and expander/implant methods, respectively. The projection of the reconstructed nipple was measured at the time of surgery and at 3, 6, and 9 months postoperatively. Results The nine-month average maintenance of nipple projection was $73.0%{\pm}9.67%$ for the LD flap group using an O-strut, $72.0%{\pm}11.53%$ for the TRAM flap group using an I-strut, and $69.0%{\pm}10.82%$ for the tissue expander/implant group using an L-strut. There were no cases of infection, wound dehiscence, or flap necrosis. Conclusions The application of an acellular dermal matrix with a different kind of strut for each of 3 breast reconstruction methods is an effective addition to current techniques for improving the maintenance of long-term projection in primary nipple reconstruction.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.44-48
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• 2021

Previously reported nipple-areolar complex reconstruction (NAR) methods involve multiple incisions and wide skin redraping, which increase retraction forces and heighten the risk of nipple-areolar complex (NAC) flattening. We introduce a NAR method using the long V-Y advancement technique that can overcome these disadvantages. A V-shaped flap is designed with the width of the flap base 4-5 mm larger than the diameter of the normal nipple. The flap length is designed to be at least 2.5 times its width. Dissection is performed to the top of the artificial dermal matrix or muscle layer. The nipple is constructed with the same projection as the contralateral side by folding the elevated flap. The tip of the elevated flap is apposed in the middle of the donor defect to minimize the deformity during donor site closure. A 3-point skin suture is applied to the upper third of the folded flap to mold its shape. Using this long V-Y advancement technique, we successfully decreased skin tension in NAC flaps and improved the maintenance of reconstructed nipple projection. The long V-Y advancement technique provides an easy, simple NAR method, effectively maintaining longer nipple projections and reducing breast deformities, especially in Asian women with relatively large nipples.

• Clinical and Experimental Pediatrics
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• v.51 no.4
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• pp.362-366
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• 2008

Purpose :The purpose of this study is to investigate the predisposing factors for nipple confusion by using questionnaires. Methods :From October, 2005 to October, 2006, we performed a survey on guardians of neonates who had been admitted to the nursery at Dongguk University Medical Center and were discharged 10 to 14 days before the survey. We reviewed their medical records retrospectively. The neonates were categorized into two groups; nipple-unconfused group and nipple-confused group. Results :There were 71 neonates in the nipple-unconfused group and 29 neonates in the nipple-confused group. In the nipple-confused group, 12 neonates (41.4%) had nipple-suckling experience before admission, whereas in the nipple-unconfused group, 54 neonates (76.1%) had nipple-suckling experience before admission; showing a difference that was statistically significant (P=0.001). Regarding to breast-feeding experience before admission, 11 neonates (37.9%) had experience in the nipple-confused group, whereas 49 neonates (69.0%) had in the nipple-unconfused group. This also showed a statistically significant difference (P=0.004). However, the relationship between the duration of breast-feeding prior to hospitalization was not different (P=0.151). Conclusion :In this study, we believe that the suckling experience and the breast-feeding of neonates before admission may be factors affecting the development of nipple confusion. This study particularly revealed that neonates who had only nipple suckling experience, regardless of breast-feeding, had less nipple confusion. Thus, allowing neonates enough time to make an attempt at nipple suckling may be helpful to prevent nipple confusion.

• Archives of Plastic Surgery
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• v.46 no.2
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• pp.129-134
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• 2019

Background Nipple-areolar complex (NAC) reconstruction is the final stage of breast reconstruction. Ideal reconstruction of the NAC requires symmetry in position, size, shape, texture, pigmentation, and permanent projection, and although many technical descriptions of NAC reconstruction exist in the medical literature, there is no gold standard technique. The technique devised by the authors is very versatile, with excellent results, and it enables 1-step reconstruction with optimal results in terms of shape and nipple projection. Methods Our technique consists of a combination of modified local flaps and a full-thickness skin graft. Patients were observed for 18 months to estimate the amount of retraction. This procedure was performed in 40 patients, four of them bilaterally. The duration of the follow-up was 30 months. Complications occurred in 10% of patients, and included infections (5%), ischemia (2.5%), and hematoma (2.5%). Results No cases of total nipple necrosis were reported. The NAC shape remained optimal in all cases, with a very small reduction of the vertical and horizontal diameters of the areola, which maintained its designed round shape well, and negligible retraction in the diameter and projection of the nipple. Conclusions The oval technique represents a major step forward, involving a combination of existing techniques, such as the C-V flap and the cutaneous graft, to achieve excellent results regarding areola shape and nipple projection, significantly reducing the cases of nipple ischemia. These results were substantially obtained through subcutaneous equatorial sutures, skin grafting, and flattening of the apexes of the flap.

• Journal of the Korea Society of Computer and Information
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• v.14 no.5
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• pp.45-54
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• 2009

In this paper, we propose an adult images detection algorithm using a mean intensity filter and an improved 2D Hough Transform. This paper is composed of three major steps including a training step, a recognition step, and a verification step. The training step generates a mean nipple variance filter that will be used for detecting nipple candidate regions in the recognition step. To make the mean variance filter, we converts an input color image into a gray scale image and normalize it, and make an average intensity filter for nipple areas. The recognition step first extracts edge images and finds connected components, and decides nipple candidate regions by considering the ratio of width and height of a connected component. It then decides final nipple candidates by calculating the similarity between the learned nipple average intensity filter and the nipple candidate areas. Also, it detects breast lines of an input image through the improved 2D Hough transform. The verification step detects breast areas and identifies adult images by considering the relations between nipple candidate regions and locations of breast lines.